L. Geffroy, W. Lowenstein, F. Bourdillon, M. Celse, W. Rozenbaum

French National AIDS Council (Paris, France)

MOAD0201Tougher policy on French illegal drug users:what impact on risk reduction?

1. BACKGROUND

- 1. BACKGROUND -

Tougher policy on French illegal drug users: what impact on risk reduction?

In the 2000’s, France’s policy on illegal drug users became increasingly stringent. The National AIDS Council sought to assess the impact of this punitive policy on risk reduction policy targeting drug users.

2000’s2000’s

2. METHODS

- 2. METHODS -

Tougher policy on French illegal drug users: what impact on risk reduction?

Around 30 hearings with representatives of the

relevant authorities associations researchers

Review of the literaturemainly collected by the French Monitoring Centre for Drugs and Drug Addiction (OFDT)

up tolife imprisonment

and €7,6 million fine(~$9,27 million)

- 3. LEGAL FRAMEWORK -

Tougher policy on French illegal drug users: what impact on risk reduction?

TRAFFIC USE

Law of 31 December 1970, regarding health measures to fight drug addiction and the repression of traffic and illicit use of toxic substances punishes:

3. FRAMEWORK

up toone year in prisonand €3,000 fine (~$3,660)

This law has not been amended since

and offers alternatives…

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

• Progression of arrests linkedto drug law offenses The number of

arrests linked to drug law offenses has increased by a multiple of 60 since 1970. From 2001 to 2007, it increased by 106%

Sources : Ministry of Interior, OFDT

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

• Progression of arrests linked to personal use of narcotics, per product (1985-2009)

Cannabis accounted for 40% of arrests linked to personal use of narcotics in 1985, 65% in 1994 and 90% in 2009

Sources : Ministry of Interior, OFDT.

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

• Progression of judicial sentenceslinked to illegal use (1984-2008)

The number of sentences laid down for drug law offences doubled between 2002 and 2008, and those for simple use have been multiplied fourfold in the past 20 years

Sources : Ministry of Interior, OFDT

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

• Progression of judicial sentences linked to illegal use (2008)

The proportion of sentences linked to personal use has increased significantly over the last decade, from 27,8% to 44,7% of sentences in 2008

Sources : Ministry of Justice, OFDT

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

The cost of this punitive policy, estimated at €590 million ($723 million) in 1995, is now much higher, given the conjoined effects of :

The cost of the network of CAARUD bodies, which specifically target users of illicit drugs users was €31 million ($38 million)in 2009…

an increase in arrests an increase in sentences for drug law offences a decrease in reduced sentences an increase in legal proceedings against personal drug users

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

Mixed results of risk reduction tools

This observation may however be offset by a number of less optimistic elements…

Based on information, access to sterile injection material and the deployment of OST, risk reduction strategies have been amplified since 1987 and explain to a large extent the slower progression of the epidemic of HIV infection among drug users

HIV HCV HIV + HCV

4. IMPACT

- 4. IMPACT -

Tougher policy on French illegal drug users: what impact on risk reduction?

Despite the requirements, the risk reduction programs have not been extended and authorities have forbidden several groundbreaking programs:

opioid substitution therapy remains insufficiently diversified (see medicalized heroin) and there is significant misuse

drug consumption rooms have not been authorized

detainees do not benefit from the full range of risk reduction mechanisms, in particular syringe exchange programs

5. CONCLUSIONS

- 5. CONCLUSIONS -

Tougher policy on French illegal drug users: what impact on risk reduction?

The punitive policy on drug users has been made a top policy and budget priority, with risk

reduction policy relegated to second place has hindered the development of risk reduction program is likely to reinforce the clandestinity of drug practices has not led to a significant increase in the price of narcotics,

nor to a fall in drug consumption

The Council recommends an evaluation of policies on illicit drugs and a reformulation of the law on narcotics

cns.sante.fr

Thank you for your attention

laurent.geffroy@sante.gouv.fr

AKNOWLEDGEMENTSChristian Andreo, Elisabeth Avril, Françoise Baïssus, Henri Bergeron, Jean-Paul Bonnetain, Betty Brahmy, Patrizia Carrieri, Pierre Chappard, Charles-Henri de Choiseul-Praslin, Anne Coppel, Jean-Michel Costes, Jean-Paul Couteron, Laurent El Ghozi, Michel Kokoreff, Aude

Lalande, Jean-Marie Le Guen, Nicole Maestracci, Olivier Maguet, Fabrice Olivet, Patrick Padovani, Michel Reynaud, Béatrice Stambul.

Members of the French National AIDS Council Gilbert Barbier, François Bourdillon, Yolande Briand, Bruno Cadoré, Piernick Cressard, Marc de Montalembert, Jean Pierre Dozon, Philippe Flandre, Thierry Foulquier Gazagnes, Philippe Gaudin, Pierre-Yves Geoffard, Claude Greff, Vichy Hai Bellahsen, Samir Hamamah, Nicole Hesnault-Pruniaux, Catherine Kapusta-Palmer, Chantal Lebatard, William Lowenstein, Jean

Massot, Pierre Mathiot, Sandrine Musso, Jean-Luc Romero, Willy Rozenbaum.

General secretariat of the French National AIDS CouncilIsabelle Batut, Julien Bressy, Michel Celse, Anny Fetter, Alexandra Moussou,

Nolsadate Sebiane, Michael Siegel.